Monday, February 16, 2015

"Can I get a bag of ice?" Can you tell me why?

After a long and great conversation with Gary Reinl about alternative recovery methods for the general exerciser to the elite athlete he told me about his best approach to getting people to not use ice as a recovery method or a treatment option for injury.

It all starts with a simple question, "You want to ice?  What's your intent?" -Gary Reinl

He talked about how this will often catch them off gaurd as they probably have never thought about it before and honestly have no idea what their reason is.  He has found that people typically come up with one of four answers:

1. Controlling Inflammation
2. Reducing Swelling
3. Promote Healing
4. Reduce Pain

All seem like reasonable options for utilizing ice until you dig into each answer a little deeper and realize that none of them actually make all that much sense.

1. The inflammatory response is a highly complex (ask anyone who has taken physiology) and a very fluid process that works to clean up all the dead tissue following injury and then move on to repairing that same are of tissue to return it a pre-injury state.  With this amazing system in place why would we want to slow it down and possibly hinder it but introducing cold as a treatment option?  If you were to ice you may slow the inflammatory response temporarily but it will inevitably start again once the tissues have been rewarmed, so why slow it down in the first place.

2. This is another area that most clinicians have admitted that ice doesn't have the ability to reduce swelling and while it may slow down the process of inflammation as we talked above it will have a problem in trying to completely stop it.  There is one system that allows your body to remove waste from an injured area, the lymphatic system.  The waste that gets created post injury is to large to be reabsorbed by the venous system to get returned through the body and the only option is has is to enter the lymph channels.  While the lymphatic system is great because it clears out all the waste it is only a passive system and cannot do its job without muscle contraction.  This is where moving as much as possible with the injured area and the surrounding musculature will help clean out the waste where ice does not have this ability.  We do not want to "freeze" out the tissue that we need to make these contractions happen so save the time and get started with the healing process by moving.

See the other reasons below:

3.  Most people have admitted that ice doesn't cause healing to occur with damaged tissue but every once and awhile you will have someone claim it can. The argument against it may be mildly extreme but the point holds true.  The extreme end of cold and ice and tissue damage is frost bite, where tissue literally dies due to cold and lack of blood flow.  While extreme it shows the damage that cold can do to tissue and helps show the point that ice will not promote healing and is most likely causing more problems than it is solving.

4. Pain is obviously one of the major problems with injury and no one wants to endure that so the solution has been for the longest time is to put ice on it.  This may cause a numbing effect for a short duration of time but for many of the reasons above adding ice to accomplish this can just make matters worse.  Why would you want to freeze the nerves that allow your body to activate the muscles need to evacuate the swelling from the injured area?  Often times the main source of pain is due to the congestion in the area due to the inflammation/swelling and by utilizing ice we just slow down the entire process and prolong it.  The best alternative is to stick with the saying "use your brain cause no pain" and move what you can to start the return of excess swelling or to find the most comfortable position you can while your body adapts to the new stressors and then allow the body to take its course of action.

There isn't much of a leg to stand on when you really look back at the bigger picture of icing.  Simply using some basic physiology and thoughts about what cold and ice can do to your body puts the thought of icing into a bad light.  Along with this thought process there is no evidence out there showing ices ability to help with any of the above answers to why someone ices.  There have been no set protocols or standards for using ice, just suggestions and the variables are too great based on the individual, the body part and the make up the area.  Think about it before you ice next time and if it is really worth doing.

Fix It Early, Fix It Often.
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